Getting Psychiatry Off the Couch

Current models of care can't meet demand; technology to the rescue?

by John Gever John Gever,Managing Editor, MedPage Today
April 04, 2017

Psychiatry's future increasingly lies on the Internet, a prominent psychiatrist declared on Monday.

The current model of care, in which doctor and patient meet in the same room for lengthy evaluations and treatment, is not working "even in highly developed countries," let alone poorer nations where there are few clinicians and millions of people live in remote villages, said R. Michael Krausz, MD, PhD, of the University of British Columbia.

"Marginalized populations ... are not having any access to care," and in his city of Vancouver, waiting times to see mental health specialists can reach 6-12 months, he said at the European Congress on Psychiatry in Florence, Italy.

The only practical solution, he suggested, is to rely on technology to bring patients and therapists together in "virtual clinics."

Computer systems offer tools for screening, monitoring, and assessment, even for emergency situations such as suicidality evaluation.

Tools for patients are available as well, Krausz said, such as apps and web portals to help them perform self-assessments, make informed decisions on treatment, and even provide therapy.

"The web is the only place where we could build and provide significant additional capacity" for mental healthcare, he said.

He said "psychoeducation" is another intervention that is proven effective, and others are under development.

And, in addition to linking patients with licensed professionals, the Internet offers opportunities to provide patients with peer support, which Krausz described as "an invaluable and most under-utilized resource in healthcare."

Peers -- "people with lived experience" to which patients can relate -- can serve as mentors or "navigators" as patients try to understand their symptoms and therapies. The web is well-suited to networking of this sort through chats, emails, video, and other channels, Krausz said.

He also argued that many technologies currently in use in conventional psychiatric treatment, such as video-based exercises and virtual reality, are easily adapted to telemedicine.